What’s The Difference Between Postpartum Anxiety And Postpartum Depression?

It's kind of a big grey area.

Valeria Nekhim Lease |
4 July 2019

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Photograph by Unsplash

If you’re a new or expectant parent, or even just thinking about starting a family, you’ve probably heard at least a little bit about postpartum depression (PPD). But what often gets glossed over in the conversation surrounding maternal mental health is the postpartum anxiety component.

Postpartum anxiety affects an estimated 15 percent of women (though that number varies a bit in the scientific research). This suggests that it’s just as common as PPD, which has been shown to affect anywhere from 10 to 20 percent of new moms.

But postpartum anxiety and postpartum depression are closely related. Historically, medical experts and resources have used “postpartum depression” as an umbrella term for a whole host of mood disorders that can occur in the postpartum period, including obsessive compulsive disorder (OCD), psychosis, and anxiety, explains Dr Shelly Orlowsky, a licensed clinical psychologist who specialises in perinatal mood and anxiety disorders.

The problem with grouping them all together, though, is that it may be confusing to some women who feel off during or after pregnancy but don’t feel like they have symptoms depression. There’s no one-size-fits-all diagnosis, but having a better understanding of what sets postpartum anxiety and depression apart as well as how they overlap is an important step toward getting mamas proper mental health treatment in the perinatal period.

Many new moms experience what is casually referred to as the “baby blues” — a period of feeling sad, irritated, angry, annoyed, hopeless, and/or resentful during the first couple of weeks following childbirth. (Hello, you just had a baby, and it’s a LOT.) You may feel like crying for no reason, be unsure about raising your baby, or have trouble sleeping, the American College of Obstetricians and Gynecologists (ACOG) explains. These feelings can come and go in waves, but ultimately they should resolve pretty much on their own within a week or two after welcoming your baby.

So then how is PPD different from the baby blues? PPD may last up to a year after having your baby, and it generally requires more formal treatment (like therapeutic or medical interventions). Fun fact: The latest issue of the Diagnostic and Statistical Manual of Mental Disorders (which is like the medical Bible of mental health disorders), includes a “with postpartum onset” specifier in its section on major depressive disorder (MDD) to more deliberately represent postpartum depression as its own condition. It was kinda lumped in under MDD until fairly recently.

Women with PPD frequently report having an intense feeling of being overwhelmed by motherhood and may even question whether they should’ve become a mom in the first place, Orlowsky describes. Another recurring thread, she says, is just not feeling like yourself, or feeling out of control without knowing why.

She’s also had patients who report feeling nothing, or being emotionally numb; they’re simply going through the motions without any interest in their babies, or life in general. Some moms may harbour thoughts of harming herself or her baby. As you can see, postpartum depression is pretty complex and can look very different from person to person. (Oh, and it can affect new dads, too.)

It’s worth pointing out that with any pregnancy-related mood disorders, the term “postpartum” can be misleading. That’s because symptoms can pop up during your pregnancy or after you give birth. So, you may also hear “perinatal” used, which more generally implies the time before and after childbirth.

Symptoms of postpartum anxiety are a little different.

Postpartum anxiety isn’t listed as its own thing and doesn’t have a specifier in the DSM. But your doctor might still use the term to describe how you’re feeling and to diagnose you — it’s a standard term in the medical world.

Orlowsky describes PPD as a loss of heart, and postpartum anxiety — or perinatal generalized anxiety disorder — as a loss of a normal sense of balance and calm. Women with postpartum anxiety specifically aren’t necessarily dealing with depression.

Rather, women with postpartum anxiety on its own may feel as if they are in a constant state of arousal, agitation, and worry, she explains. They may feel unable to quiet their mind no matter how hard they try, or have trouble sitting still or getting to sleep.

Some moms with postpartum anxiety have disturbing “what if?” thoughts about bad things happening to the baby. They may be afraid to get into the car with their child, or are uncomfortable leaving him or her with anyone else. Moms who suffer from intrusive thoughts like this may not be able to respond to reason, Orlowsky notes. (For instance, even though deep down you *know* your partner is home with the baby while you go out to run errands and everything’s okay, you might be compelled to turn back and go through a safety checklist again.)

Like it’s relative PPD, postpartum anxiety is treatable. That being said, because PPD has been studied and discussed at much greater lengths, many moms with postpartum anxiety don’t recognise they have it, and it often goes undiagnosed. Another reason moms with postpartum anxiety don’t realize they have a problem or delay seeking help is because they don’t know how much anxiety is to be expected or “normal,” versus how much is too much—even for a new mom.

You can have symptoms of postpartum depression or postpartum anxiety, or a mix of the two.

Physical symptoms of PPD are similar to those of perinatal anxiety and typically include changes in sleep and appetite, nausea, headaches, body aches, and dizziness. You can predominantly have symptoms of depression with tell-tale signs of anxiety mixed in, or the opposite.

The relationship between the two disorders isn’t fully understood, per the Massachusetts General Hospital Center for Women’s Mental Health says. It’s unclear whether having postpartum anxiety is more likely to bring on PDD, or vice versa, Orlowsky says. In one scenario, a mom can be depressed and also consumed with worrisome thoughts regarding her baby’s safety. On the flip side, a mom’s anxiety may become so cumbersome that it leads her to have depression symptoms as well.

Women with PPD or anxiety (or a combo) might feel guilty or ashamed about their inability to embrace motherhood. As a result, they might have a hard time being among other moms, friends, and family members. But social isolation can end up deepening the pain of it: “Postpartum depression and anxiety are so draining [that] moms don’t want to be around other people — but that’s precisely what they need,” Orlowsky says.

It may not seem like distinguishing between the two really matters, but it does. Perinatal mood disorders are not black and white for every person, and that’s totally okay. But being able to describe your symptoms to your doctor, whether they take the form of anxiety or depression or seem to be some hybrid, helps your physician tailor a treatment plan to fit your needs.

If you think you have postpartum depression and/or anxiety, these are your next steps.

If you just feel off, and feelings of anxiousness or depression are making you unable to function properly from day to day for longer than two weeks, you likely need to seek out professional help.

But if you’re not ready for that step (hey, no judgment), start by sharing how you’re feeling someone you trust. This can be a friend, family member, doula, or a medical professional. “You don’t have to be able to diagnose yourself, but you know when you have a cold versus the flu,” Orlowsky explains. (In other words, you have the best sense of what feels normal or not for you.)

Ideally, your paediatrician or obstetrician has screening measures in place to assess whether you are exhibiting symptoms of postpartum depression or anxiety, after which they can refer you to a clinician who specializes in perinatal mood and anxiety disorders.

What’s more, if you have dealt with anxiety and/or depression during a previous pregnancy or were diagnosed with both or either one of these conditions prior to having kids — it’s important to address that with your obstetrician. A woman who has had PPD or postpartum anxiety in a previous pregnancy is 50 percent more likely to develop it in a subsequent pregnancy, according to Orlowsky. That said, you may not have had either with your first child (or multiple children) but could still develop it during subsequent pregnancies.

Treatment absolutely exists for both postpartum anxiety and postpartum depression—and you deserve it. Some women may benefit from one-on-one therapy and/or support groups when dealing with PPD and/or anxiety, while others may also require medication. When Orlowsky thinks a patient could benefit from medication, she refers them to a reproductive psychiatrist.